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The Effect of Cemented Implants Placed During Initial TKA on Surgical Time and Expenses in Revision TKA
Adam Kohring1, Nihir Parikh, John Hobbs
1From the Jefferson Health New Jersey (Kohring), Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Parikh, Hobbs, and Krueger), Midwestern University, Downers Grove, IL (Lowitz), and Panorama Orthopedic & Spine Center, Golden, CO (Gold).
Introduction:
Revision total knee arthroplasty (rTKA) is a complex procedure that often requires the removal of previous implants. There is little information evaluating the difference between removing cemented or noncemented knee prostheses in revision surgeries. The purpose of this study was to determine whether removing cemented or noncemented implants would affect surgical time and expenses incurred during revision procedures.
Methods:
This retrospective cohort study used a single-institution database to identify 300 patients who underwent femoral and tibial implant rTKA from 2016 to 2022 because of mechanical complications (infection cases excluded). Radiographs and surgical reports were used to confirm whether the fixation technique was cemented (N = 243) or noncemented (N = 57). The primary outcomes were surgical time and surgery costs. Secondary outcomes included readmission rates, revision implants used, stem usage, and insurance type.
Results:
The average surgical time was 121 minutes for noncemented and 128 minutes for cemented procedures ( P = 0.118). The 90-day readmission rates for each group were similar at 7.00% for the cemented cohort and 8.77% for the noncemented cohort ( P = 0.643). For patients with Medicare Advantage, the respective surgery costs were $1,966 for noncemented and $1,968 for cemented TKA ( P = 0.988). For patients with commercial insurance, the respective surgery costs were $4,854 for noncemented and $5,660 for cemented TKA ( P = 0.330).
Conclusion:
Primary knee fixation type, cemented or noncemented, did not appear to influence the surgical duration or surgical costs of both-implant revision knee surgery indicated for mechanical complications.
